Laserfiche WebLink
APPLI C.ATI ON 1 Urt PIRM i T 7 <br /> SAN JOAQUII, COUNTY PUBLIC HEALTH SERVICES <br /> ETI V I R0Nu-wxTAI,, tibALTFI IJ I V! 6I C)N <br /> P 0 J30X 2009 , STOCKTON , CA 95201 <br /> (209) 488--3447 <br /> (Complete is Triplicate) <br /> 4711t►ttou is hercloy mode t.o Sea JoaQula County 'or a pernit ..e conat..%ct aid/or ItsulI the w-1 hertln detc-Abid 7?1 <br /> J <br /> PPllcatlOD Is eadt In Cc.P'I.rce vitt .4.4z.z Jo ;lwl't Cou:ty Ord rrnct No 5=9 ►tt.: IC,62 a„I_- tbg R-.Jcp > s! RTgvjatIO,- or seg <br /> o.avla Coxaty Public lfealt„ t3erY1ces <br /> Job Address T City r' Cr? ;ot 9lit/l.rt►ge -} O 5- <br /> e-44.e4 <br /> Owrwr a Name L ACGrest ZZI 24,1 r i, rl7 PnOru d '�- + <br /> pr9!�.ItS, Tf< 75z�1 <br /> .onto aC1Dr .•A- AdO cff r Cinle ND4,�7 ��z0 F"tOfk 916gS� 74�°t a <br /> TYPE OF WELL/PUMP NEW WELL ) WELL REPI ACEMEN-T O DESTRUCTION L-) Out of Seryl;e Veil ❑ <br /> PUIr1P INSTALLATION C SYSTEM REPAIR 0 OTHER (: '+captor!*.� Ytl1 <br /> DISTANCE TO t.EAREST SEPTIC TANK SEWER LINES DISPOSAL FLD PROP LINE <br /> FOUNDATION AGRICULTURE_WELL OTHER WELL PITS/SUMPS <br /> INTENDED U5E nPE OF WELL PAOBLEAA AAEA CONSTRUCTION SPECIFICATIONS <br /> 4 Industrial D Open Bottom Q minleta OLS Of Wall E■cawl On <br /> Osd of 1YoI+ Clarn.p <br /> Lr DomearKlPrPvata 0 G,a.o pact 0 Tracy Typo Of Ca3rn9 $peers Ce lron3 <br /> 1 © PuDlt I 01her O Della Drplh of Glow Seat Typq of Grovr r0 it „ r <br /> G lit-041100nArvoa Dep h ❑ Eittarn ea Installad by <br /> y� kSPnitnf4 <br /> Surface S <br /> Repair wart Dors# U 'hype Of Pump _ K P Slate <br /> Weu Nstructron C► wtu Disrriv r _ 5ca-lirid Xeterfd: 'i Dtytt <br /> Dyplh �s_ Tills FEa ar1ill i D#gth #�2 9 tli Sots <br /> TYPE OF SEPTIC }VORX NfW INSTALLATION 0 REPAIR rA001TION LI DESTRUCTION Cr IN* aeplrc ty3fern per-rvllad if p1+Llt 3vwe, u <br /> avarlab-a %vrlhrn 200 1"1 I <br /> 10 fnetallllran will ”" Aesrdenct _,. Car.srnerc,ar Dlher <br /> Number Of lrvrn9 unrla Nurnbe, of boC,00rnf <br /> CN,atter of w1 10 a depth of 3 teel Water table depth <br /> SEPTIC TANK ❑ TyjefhtfQ C+pell NO Companrrsenra <br /> PKG TAEATMENT PLT [l l4larhod of 0MPCLat <br /> Oriente to r+earnt Well founder on Property Lan• <br /> LEACHING LINE 0 No A Length o= IPnes To+a bngth/uta <br /> FILTER EED n owanc# ty M7rbst WaA Fountatron _ Fropeny L" l <br /> SEEPAOE PITS 1 I 04plh Sve Nvenber <br /> SUMPS LI Dralsnu to na4reet Wal; four,dauon Pl <br /> DISPOSAL PONDS o oobrtY ty" <br /> I Mreby canny that I hav# prepar,< this apptres Pori and 'hal the work writ p* done in #CCar,'InCe WWI San JOaQrlrri tourty ordinances fiat@ taws J'14 <br /> rules and re9vlaf.Ons of the San Josgv+n Cwnty <br /> Ham! Own#r Or Irc#naad eaenl s Knalvre cert (-at the f^slow n0 I certify that 1n Ina Wye.'rnanttl 01 the Work for Wfuth fh-a P#rrrkt r3 wuod I shall not <br /> #mPIOV any person t7 wch n%j^r.sr ea to tMCOTt wbrecl to woikrnan a Cornperlduon Law3 0t� Cah(prry,a COrilra•I0r L hPhnQ Or sv1}Contracling s+Qra'Ura <br /> hon LiIm of GfJllprnlrt C#r}tl11'69 fplbwrn9 I C#r�fy that in Aha p�rfJrrrance of IIH wort for .vhrch thra per�nll it PLaued I ILII employ porscns 3vbraCI to v ,a <br /> .prlrnsn a corr, nu <br /> Tha appttcanl et,31 G411 rd,,,-4d repu�,f rr`fpe tor It CO-rpo'a drawnQ pn re,arw 3rd• <br /> TPlla Dale <br /> POR DEPARTMENT USE ONLY <br /> pptrcahon Ageaq+#d by Oe=. A,eJ <br /> It or Orout Ir4pecl-on by pelt F1na1 Impacw by <br /> Iona! Comrr,#nta <br /> gy11C►at - 5#iurM LU C0y1#2 to SLv JC)AQUIY COUNTY PUBLIC HxkLTV SUVICFS <br /> VIVIR0hWLXT,LL XULTIf DIVISICW PUMIT/3&AYICE3 <br /> «S Y 3Alt J01QUIh, P 0 8l]If 2449, yiVCYTOH, CA D5102 <br /> f(I AI.IOijhT Ou( ALaGUk,' AE+arREO CK <br /> IN10 Crer r <br /> ISH f t.E vEO Pv O*Tf FIAMr7 )a0 <br />